Up to now few years, state and native governments throughout the U.S. have begun spending billions in opioid settlements paid by firms accused of fueling the overdose disaster. However the place is that cash going, who’s getting it, and is it doing any good?
KFF Well being Information, partnering with the Johns Hopkins Bloomberg College of Public Well being and Shatterproof, a nationwide nonprofit centered on dependancy, undertook a yearlong investigation to seek out out.
Dozens of interviews, hundreds of pages of paperwork, an array of public data requests, and outreach to all 50 states resulted in a first-of-its type database that catalogs greater than 7,000 methods opioid settlement money was utilized in 2022 and 2023. It’s probably the most complete useful resource so far monitoring among the largest public well being settlements in American historical past.
Among the many findings:
- States and localities obtained greater than $6 billion in opioid settlement funds in 2022 and 2023. In accordance with public data, they spent or dedicated a couple of third of that quantity and put aside about one other third for future use. The ultimate third was untrackable, as many jurisdictions didn’t produce public experiences on the funds.
- Experiences of spending tracked the minuscule to the monumental, from $11.74 to purchase postage in Yavapai County, Arizona, to greater than $51 million to extend the dependancy therapy workforce in California.
- States allotted, on common, about 18% of their funds for dependancy and psychological well being therapy; 14% for restoration companies corresponding to housing, transportation, and authorized assist; 11% for hurt discount efforts corresponding to overdose reversal drugs; and 9% for prevention applications that intention to cease individuals from creating substance use problems. States dedicated, on common, about 2% for syringe service applications, by which individuals can get sterile needles. (A wide range of entities obtained this cash, from regulation enforcement to nonprofit organizations to authorities businesses.)
- Governments reported spending greater than $240 million on functions that didn’t qualify as opioid remediation. (Most settlements permit states to spend as much as 15% of their funds this manner.) Most of this tranche went to authorized charges, however a number of jurisdictions funneled cash to their common fund. One county even despatched funds to its highway and bridge division.
- A number of cities and counties reported expenditures they stated addressed the overdose disaster however that would depart a mean individual scratching their head — corresponding to $33.07 to an anti-abortion being pregnant heart in Sandborn, Indiana, and $30,362 to display screen first responders for coronary heart illness in Oregon Metropolis, Oregon.
“When people know that people aren’t watching and there’s no accountability, then they can kind of do what they want,” stated Tonja Myles, a group activist in Baton Rouge, Louisiana, who’s in restoration. “That’s why we have to have some kind of database and accountability.”
Regardless of the latest decline in general overdose deaths within the U.S., greater than 90,000 individuals nonetheless died within the 12 months ending July 2024 and charges are rising in lots of Black and Native American communities.
“We can’t mess up or miss this moment,” Myles stated.
Opioid settlement payouts are anticipated to whole about $50 billion over almost twenty years, paid by greater than a dozen firms that made or distributed prescription painkillers, together with Johnson & Johnson, Walgreens, and Walmart. Though it’s a big sum, it’s dwarfed by the dimensions of the disaster, making every greenback that’s spent important.
KFF Well being Information and its companions reviewed lots of of settlement spending experiences, extracting expenditures line by line, and developed a strategy to kind the expenditures into classes like therapy or prevention. States got a chance to overview the information and touch upon their spending.
To make sure, the database doesn’t seize the complete image of opioid settlement spending nationwide. Some locations don’t publish spending experiences, whereas others declined to have interaction with this undertaking. The information offered here’s a snapshot as of the top of 2023 and doesn’t account for additional spending in 2024. The variations in how states management, course of, and report on the cash make apples-to-apples comparisons almost unimaginable. Nonetheless, the database helps fill a niche left by a scarcity of nationwide reporting necessities and federal authorities inaction.
It’s “a tool for those who want to objectively measure whether everything that can be done is being done,” stated Matthew Myers, a former president of the Marketing campaign for Tobacco-Free Children, which compiles related annual experiences on tobacco settlement cash.
Therapy a Clear Winner
The highest precedence to emerge from early opioid settlement spending was therapy, with greater than $416 million spent or dedicated to residential rehabs, outpatient counseling, drugs for opioid use dysfunction, and extra.
The state of New York — which spent probably the most on therapy — allotted about $22 million of that for applications that make the gold commonplace for care as straightforward as attainable for sufferers: offering same-day prescriptions for buprenorphine, a medicine that decreases cravings for opioids.
The consequence was a program that John Greene stated modified his life.
Greene, 57, used to dwell within the woods down the road from Household & Youngsters’s Counseling Providers in Cortland, New York. He cycled by jails and hospitals, overdosing half a dozen instances and attempting rehab simply as many.
However now he has 4 months of restoration beneath his belt — the longest stint since he began commonly utilizing medicine at 14.
He stated it’s as a result of the counseling heart’s new program — funded by a mixture of state and native opioid settlement {dollars} — has a unique strategy. Counselors aren’t didactic and judgmental. They don’t power him to quit smoking marijuana. A number of employees members have skilled dependancy themselves. They drive Greene, who doesn’t have a automotive, to physician appointments and the pharmacy for his buprenorphine prescription.
Now Greene lives and works together with his brother, appears to be like ahead to weekly counseling periods, and is notching small victories — corresponding to shopping for his nephew toy automobiles as a stocking stuffer.
“It made me feel good to do something for somebody and not expect nothing back,” Greene stated.
Emily Georgia, one in every of Greene’s counselors, stated the middle has labored with almost 200 individuals like him prior to now 12 months. With out the settlements, “the program probably wouldn’t exist,” she stated.
Throughout the nation, the cash helps different progressive therapy approaches:
- $21 million for a brand new program in Kentucky that diverts individuals with psychological sickness or dependancy who face low-level expenses away from incarceration and into therapy, training, and workforce coaching
- Greater than $3 million for, partly, three new cell methadone applications in Massachusetts, to convey the remedy to rural and underserved areas
- Tens of hundreds of {dollars} every in Iowa and Pennsylvania to cowl out-of-pocket therapy prices for individuals with out insurance coverage or these with excessive deductibles
Philip Rutherford, an professional on substance use dysfunction on the Nationwide Council for Psychological Wellbeing, stated these efforts “are really positive” and plenty of have been “historically difficult or impossible to achieve with federal or state funding.”
However some funds are additionally flowing to therapy approaches that defy finest practices, corresponding to denying individuals drugs for opioid use dysfunction.
Some within the restoration group think about methadone and buprenorphine a crutch. However research after research present that the drugs assist individuals keep in therapy and scale back the danger of overdose and demise. Analysis even suggests that therapy with out these drugs may be extra dangerous than no therapy in any respect.
Though not everybody will need remedy, settlement funds shouldn’t “prop up a system that doesn’t allow people to have that choice,” stated Regina LaBelle, a professor of dependancy coverage at Georgetown College.
Infants, Forgotten Victims of the Epidemic
Whereas therapy obtained a windfall in early opioid settlement spending, one other facet of the disaster was uncared for: neonatal abstinence syndrome, a situation through which infants uncovered to medicine within the womb expertise withdrawal.
Nationwide, greater than 59 newborns a day are recognized with it. But solely about $8.4 million in settlement cash was dedicated to the problem — lower than 0.5% of all funds publicly reported as spent or dedicated in 2022 and 2023.
Consultants in public well being and dependancy, in addition to affected households, say it’s because of stigma.
“A mom using drugs and being a parent is a very uncomfortable reality to face,” stated Ashley Grant, a 38-year-old mom of three in Mesa, Arizona. “It’s easier to just push it under the rug or let them fall through the cracks, as sad as that is.”
It virtually occurred to her.
Grant discovered she was pregnant together with her third youngster final 12 months. On the time, her companion was in jail and he or she was utilizing medicine after an eight-year interval of restoration, was estranged from her household, and didn’t know the way she’d survive the following 9 months.
Throughout a go to to a methadone clinic, she noticed a sales space about Jacob’s Hope, a specialty nursery that cares for substance-exposed newborns and their mothers. Nursery employees linked her with a therapist, helped her enroll in parenting courses, and dropped off diapers and a playpen at her dwelling.
After delivering on the hospital, Grant and her child boy stayed at Jacob’s Hope for a couple of week. Nurses confirmed her how skin-to-skin contact calmed his withdrawal signs and extra frequent feedings and burpings decreased gastrointestinal discomfort, which is frequent amongst substance-exposed newborns.
As we speak, Grant has roughly 5 months of restoration. She bought licensed as a peer restoration specialist and hopes to hitch Jacob’s Hope at some point to assist mothers like her.
However the nursery’s future is unsure.
After opening in 2019, Jacob’s Hope almost shut down this summer season because of low reimbursements and delayed funds from insurers, stated Lyndsey Steele, its affiliate director. Group donations saved the nursery afloat, however “it’s still hanging on by a thread,” she stated.
She’s hoping opioid settlement cash may also help.
In 2022, Jacob’s Hope obtained about $250,000 from Arizona’s opioid settlements. However this 12 months, the legislature captured the state’s share of remaining funds and, in a controversial transfer, gave it to the Division of Corrections.
Jacob’s Hope has now turned to native governments, which management their very own settlement {dollars}. Its dwelling metropolis of Mesa stated a primary spherical of grant purposes ought to open within the spring.
Steele prays it received’t be too late for infants in want — the epidemic’s “forgotten victims,” she known as them.
Coronary heart Illness Screening, Robotic Ambulances, and Extra
Some opioid settlement expenditures have sparked fierce disagreement. They typically fall into three buckets: cash for regulation enforcement, funding for youth prevention applications, and purchases unrelated to the opioid disaster.
Settlement {dollars} nationwide have purchased physique scanners, Ok-9 items, bulletproof vests, patrol vans, and laptops and printers for police and sheriffs.
Some spending strayed even farther from the spirit of the settlement. In Oregon Metropolis, Oregon, greater than $30,000 was spent on screening first responders for coronary heart illness. Police Chief Shaun Davis stated his employees reply to opioid-related emergencies and expertise trauma that will increase their danger of coronary heart assault.
However some individuals query if settlement funds needs to be footing the invoice.
“This looks to me like you’re trying to defray other costs” from the police finances, stated Stephen Loyd, chair of Tennessee’s Opioid Abatement Council. “I don’t think that there’s any way that this opioid money was earmarked for stuff like that.”
A second space of competition is youth prevention.
Though most individuals agree that stopping youngsters from creating addictions is vital, the execution is hard.
Practically half 1,000,000 settlement {dollars} have gone to the Drug Abuse Resistance Schooling program, generally often called D.A.R.E. Many years of analysis counsel its authentic curriculum is ineffective.
Robeson County, North Carolina, spent about $10,000 in settlement cash to purchase “Andy the Ambulance,” a robotic ambulance with large eyes and an audio system by which a human operator can talk about the hazards of medicine. EMS Director Patrick Cummings stated his crew has taken the robotic to church buildings and elementary faculties.
We “don’t have any studies that show it’s working,” he stated, however educating youngsters looks as if a great funding as a result of “if they never try it, they don’t get addicted.”
Then there’s the chunk of cash — as much as 15% of every state’s funds — that’s a free-for-all.
Flint, Michigan, spent almost $10,000 on an indication for a group service heart. The town reported that the expense didn’t qualify as “opioid remediation.” In different phrases, it’s unrelated to addressing the disaster.
However Caitie O’Neill, a metropolis spokesperson, stated that “the building sign makes it possible for residents to find” the middle, which homes metropolis companies, “including Narcan kits, fentanyl testing strips, and substance abuse referrals.”
Jurisdictions throughout 29 states reported non-remediation spending in 2022 and 2023. Most opioid settlements require such experiences however function on an honor system. Nobody is checking if the opposite 21 states and Washington, D.C., have been truthful.
Jackie Lewis, an Ohio mom whose 34-year-old son, Shaun, died of an overdose in October 2022, finds that arduous to abdomen.
“This is blood money,” she stated. Some individuals have “lost sight of that.”
Lewis is elevating Shaun’s daughter, guaranteeing the 9-year-old receives counseling in school and might attend the hip-hop music courses she enjoys — all on Lewis’ Social Safety funds. This 12 months they moved to a smaller city with decrease prices.
As settlement funds proceed flowing, she desires officers in control of the cash to assist households like hers.
“We still exist and we’re still struggling,” she stated.
KFF Well being Information’ Henry Larweh and Megan Kalata, Johns Hopkins Bloomberg College of Public Well being’s Sara Whaley and Vivian Flanagan, and Shatterproof’s Kristen Pendergrass and Sahvanah Prescott contributed to this text.
The Johns Hopkins Bloomberg College of Public Well being has taken a number one position in offering steering to state and native governments on using opioid settlement funds. School from the varsity collaborated with different consultants within the area to create ideas for utilizing the cash, which have been endorsed by over 60 organizations.
Shatterproof is a nationwide nonprofit that addresses substance use dysfunction by distinct initiatives, together with advocating for state and federal insurance policies, ending dependancy stigma, and educating communities concerning the therapy system.
Shatterproof is partnering with some states on tasks funded by opioid settlements. KFF Well being Information, the Johns Hopkins Bloomberg College of Public Well being, and the Shatterproof crew who labored on this report should not concerned in these efforts.
